Basic Information
| Provider Information | |||||||||
| NPI: | 1366429623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40074 CANNES CT | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925911634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516993860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27450 YNEZ RD | ||||||||
| Address2: | STE 120 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925914671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516955144 | ||||||||
| FaxNumber: | 9516959345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT6711 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.